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Research letter
Evaluating hypoxia during air travel in healthy infants
  1. Mansi Khanna1,
  2. Claire Shackleton2,
  3. Maureen Verheggen3,4,
  4. Mary Sharp5,6,
  5. Andrew C Wilson3,4,
  6. Graham L Hall3,4
  1. 1Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
  2. 2Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
  3. 3Respiratory Medicine, Princess Margaret Hospital, Perth, Western Australia, Australia
  4. 4Paediatric Respiratory Physiology, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
  5. 5Neonatology Clinical Care Unit, King Edward Memorial Hospital for Women, Perth,  Western Australia, Australia
  6. 6Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Professor Graham Hall, Paediatric Respiratory Physiology, Telethon Institute for Child Health Research, PO Box 855, West Perth, WA 6872, Australia; grahamh{at}ichr.uwa.edu.au

Abstract

Up to a third of ex-preterm infants flying near term exhibit pulse oxygen saturation (SpO2) of less than 85% during air travel. A hypoxia challenge test (HCT) is recommended to evaluate the requirement for in-flight supplemental O2. The validity of the HCT in healthy, term infants has not been reported. This study aimed to characterise the in-flight hypoxia response and the accuracy of the HCT to predict this response in healthy, term infants in the first year of life. Infants (n=24: (15 male)) underwent a HCT prior to commercial air travel during which parents monitored SpO2. Thirty-two flights were undertaken with six infants completing multiple flights. The median in-flight SpO2 nadir was 87% and significantly lower than the HCT SpO2 nadir (92%: p<0.001). Infants on seven flights recorded SpO2<85% with one infant recording a HCT with a SpO2 less than 85%. There was marked variability in the in-flight SpO2 in the six infants who undertook multiple flights, and for three of these infants, the SpO2 nadir was both above and below 85%. We report that in healthy term infants an in-flight SpO2 below 85% is common and can vary considerably between flights and that the HCT poorly predicts the risk of in-flight hypoxia (SpO2<85%). As it is common for healthy term infants to have SpO2 less than 85% during air travel further research is needed to clarify whether this is an appropriate cut-off in this age group.

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